New ARC / NZRC Guidelines Released

The Australian and New Zealand Resuscitation Councils recently have jointly developed and published the modified resuscitation guidelines for Basic, Advanced, Paediatric and Neonatal Life Support.

 

The much anticipated changes are in keeping with new revisions published by the International Liaison Committee on Resuscitation (ILCOR) and take into account the latest evidence-based reviews of resuscitation science.

 

As a joint undertaking between ILCOR and The American Heart Foundation, the review is a formal response to the growing debate over whether in some circumstances, chest compressions alone may be the best approach.

 

Associate Professor Paul Middleton, Chairman of the Australian Resuscitation Council (NSW) said that current research suggests that many paramedics and doctors actually over-ventilate, “...this stops blood from coming back into the chest because of increased pressure. Just tilting the head back and starting compressions is effective. CPR has become a lot simpler. It works, but we know that someone needs to start CPR as soon as possible without stopping and just keep going.” he said.

 

Of course, as the Australian Resuscitation Council (ARC) is quick to point out, hands-only CPR is not effective in a variety of circumstances, such as cardiac arrests involving children; cases of drowning; in-hospital cardiac arrests, and resuscitations attempts beyond three minutes.

 

In response to these concerns, the new guidelines now recommend that 30 chest compressions be provided before giving the initial rescue breaths. The compression to ventilation ratio remains at 30 compressions to 2 ventilations.

 

The new guidelines also place great emphasis on the importance of commencing resuscitation and providing good quality CPR. They state that resuscitation should be commenced whenever a person is unresponsive and not breathing normally, as feeling for a pulse is unreliable in determining if a person needs resuscitation.

 

The ARC and NZRC also recommend that if a person is unwilling or unable to provide full CPR (i.e., chest compressions and rescue breathing) they should provide continuous chest compressions at a rate of just over 1 per second.

 

The major changes to the ARC guidelines are as follows:

Guideline 2 - Priorities in an Emergency

This section now covers a range of emergency situations, such as collapsed and injured victims, and not just cardiac arrest.

Guideline 3 - Unconsciousness

This section now focuses on the breathing unconscious victim. Non-breathing unconscious victims are hereafter addressed under Guideline 8 (CPR)

 

Guideline 5 - Breathing

  • References to signs of life have been removed as they are open to interpretation, and feedback suggested that the term ‘signs of life’ is confusing.
  • There is a renewed focus on ‘unresponsive and not breathing normally’ as indicators for resuscitation.

 

Guideline 6 - Compressions

  • References to ‘signs of life’ have been removed to avoid confusion
  • There is a renewed focus on ‘unresponsive and not breathing normally’ as indicators for resuscitation.
  • If a rescuer is unable / unwilling to perform CPR, then perform compression only CPR
  • The pulse check had been downgraded as it is considered an unreliable indicator of the need for resuscitation
  • There is a new emphasis on maintaining CPR quality and a recommendation that rescuers change every 2 minute to decrease fatigue and maintain depth and rate of compressions
  • A new section has been added on the use of prompt devices in clinical use as part of an overall strategy to improve CPR quality

 

Guideline 7 - (New)

  • A new guideline has been added which recognises the role of AEDs as part of BLS in both out of hospital and in hospital environments
  • Clear recommendations are made that training in AED use should be part of BLS

Guideline 8 - CPR

  • Increased emphasis on bystander CPR as lifesaving intervention
  • Compression rescue breathing ratio remains at 30:2
  • Resuscitation steps are now DRS ABCD – the ‘S’ has been added for ‘send for help’
  • Major change: In a victim who is unresponsive and not breathing normally, CPR commences with compressions rather than rescue breaths
  • If unwilling to perform rescue breaths, then perform compression only CPR

Guideline 10 - CPR Training

  • Regardless of the recency of CPR training, any attempt at resuscitation is better than no attempt
  • The ARC recommends that individuals trained in CPR should refresh their skills annually

 

A full copy of the revised guidelines is available from the ARC website at www.resus.org.au or the NZRC website at www.nzrc.org.nz